Alternative Systems of in lndia: An 0verview Chandrukant Luhariya raditional Medicine those not originated in India, i.e. (TM) with . This article aims to (a) along The history of medicine Complementary summarize the evolution of different Medicine (CM) and types of medicine since antiquity; (b) indicales thut olmost every provide an overview ofASM in India; muior civilizotion und tulture (c) suggest a way forward as the (AM) are terminologies and hod developed their own system that are often used interchangeably for' country intends to progress towards curing diseoses, though lhe a broad range ofhealthcare practices, Universal Health Coverage (UHC). for theory, service delivery and systems opprouthes varied. From the Evolution of Medicine Since Ancient in both Eastern and Western parls of very beginning ol the humon the world (including for Ayurvedic Times there hos been on traditional civilization, medicine, naturopathy, The history of medicine indicates interest in controlling diseuses, Chinese medicine and homeopathy that almost every major civilization etc.) that have developed separately and culture had developed their ensuring good heolth und system of from the conventional own system for curing diseases, prolonging life. (Box These systems, medicine l). though the approaches varied. From all put together are referred to as the very beginning of the human Traditional and Cornplementary civilization, there has been an interest (T&CM). names of the civilization. The early Medicine in controlling diseases, ensuring good medicine practices, around 3000 BC health and prolonging life. Medicine India has a rich culture of T&CM, to 3500 BC, started independentlY in ancient form was practiced in all hereafter used interchangeably in in every culture, which then started societies and civilizations-Egyptian, this article, the alternative systems influencing each other starting 200 (ASM), which include Chinese, Indian, Mesopotamian, of medicine BC, with a major convergence around Greek, Roman and Arab/Unani-and both Indian/indigenous systems i.e.. 800 AD onwards with the evolution Ayurveda and Siddha as well as is referred to and recognized by the

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The author is National Professional Officer with the World Health Organization, based at New Delhi.

YO.IANA June 2019 25 of Arab medicine (Box 2). The dawn of scientific or modern medicine Box 1: Traditional and Complementary Medicine-Definitions started in the mid of the 15th century. o Traditional Medicine (TM): The sum-total ofthe knowledge, It evolved on the foundation created skill and practices based on the theories, beliefs and experiences indigenous by the ancient systems of medicine to different cultures, whether explicable or not, over a period of 4500 years (2500 used in the maintenance of health as well as in the prevention, diagnosis, improvement BC-1500 AD). In the mid of the or treatment of physical and mental twentieth century, the stream of illness. medicine based upon the concept of o Complementary Medicine (CM) or Alternative Medicine (AM): 'treatment of diseases by use of a A broad set of healthcare practices that are not part of that country,s drug which produces a reaction that own tradition or conventional medicine and are not fully integrated itself neutralizes the disease condition into the dominant healthcare system. In some countries, the term or disease-causing agents' started Traditional Medicine (TM) is used interchangeably with CM and getting popular and is now known as AM and also together as 'Complementary and Alternative Medicine, Allopathy or Allopathic Medicine. (C&AM) and are used interchangeably. These systems typically use a Allopathy is the most commonly used variety of methods that fal1 under the cAM umbrella (herbal remedies, system of medicine in India and most manipulative practices). other parts of the world. Most often, o Traditional and Complementary Medicine (T&CM): T&CM it is Allopathic medicine compared merges the terms TM and CM, encompassing products, practices and to which other systems are termed practitioners. as traditional, complementary or alternative systems of medicine.

India and Alternative Svstems of was formed in November 2014. In 7'13,668 already registered AyUSH Medicine 2002, the Government of India also practitioners, most of them being in formulated the National Policy on Ayurveda followed by Homeopathy. In the last three decades, there have Indian Systems of Medicine and There were 622 institutions offering been focused initiatives to mainstream Homeopathy. under-graduate courses (annual traditional and alternative systems of intake of 40,151) and 201 institutes medicine in healthcare services in Sustainedeffortsoverthevearshave resurted in an increaslg, India. The first full-fledged department i,l[l,J,'i::,oili.f,ffU;il',!?#f] ol providers in alternative:Iil1r.,",g for lndian Systems of Medicine and systems (rable,;-;-,-. or l)' Homeopathy (iSM&H) was created medicine. By the .;;;iilffi 2017 there were policy under the Ministry of Health and , 3,943 hospitals and The current National Health 27,698 dispensaries Family Welfare, Government of India, under AYUSH of India has proposed functionar systems, under in March 1995 to promote and regulate different administrative linkage ofAyuSH at all levels ofhealth controls ranging from the practice of alternative systems of State and Union systems, including service delivery as governments, local medicine in the country (Box 3). This bodies and others well as work force. The policy proposal (i.e. yoga deparlment was, in November 2003, Central Government Health focuses on inclusion of at work- Services renamed as Department of Alurveda, (CGHS); Railway, Coal place, in schools and in the community and Labour Yoga and Naturopathy, Unani, Siddha Ministry and also run as an important form of promoting and Homeopathy (AYUSH). A fully by research councils and national health and wellness. The utilization of independent Ministry of AYUSH institutes). In March 2018, there were AYUSH services, ranges from 5-10 per

Table 1: Human resource availability and production capacity for The current Notionol Heulth Policy traditional and alternative systems of medicine in India (March 2017) of lndio hus proposed functionul Already Under Graduate Post Graduate courses linkoge of AYUSH ot oll levels of Registered course heolth systems/ including servire practitioners No of Annual No. Annual Institutions intake Institutions intake delivery os well os work force. Ayurveda 428,884 338 2t.387 135 4,t22 The polity proposol focuses on Unani 49,s66 49 2,705 11 127 intlusion of Yogo ol workploce, in Siddha 8,505 09 520 02 94 schools ond in lhe community os Naturopathy ) )4) 25 1,630 03 45 qn promoting Homeopathy 284,47t 201 13.909 50 1098 importont form of TotalAYUSH 773,668 622 40,151 201 5,486 heolth ond wellness.

Source: National Health Profile of India, 20 1 8.

26 YOJANA June 2019 tl1.rr11,111 - {,'

Box 2: Evolution of Medicine SinceAntiquity o Indian Medicine: Medicine in India originated around 3000 BC, when the practice ofAyurveda is considered to have started' In addition, the Siddha system of medicine is also Indian in origin. the peritd of g00 BC to 600 AD is regarded as the golden period for Indian medicine, a period which coincides with widely accepted authorities in Ayurvedic medicine, such as Atreya, charaka and Sushruta. of them, atreya l"urr, s6,, BC) is considered as the first great Indian physician and teacher. Charaka (200 AD; also written as iaraka) wrote Choraka samhita and was the most popular physician of the time. Sushruta is referred to as the father of Indian surgery. He wrote sushruta samhita,atreatise on surgery (between 800 BC and 400AD). Around g00AD, the charaka and sushruta samhitas were translated into Persian and Arabic and Indian medicine had spread to Indo-china, lndonesia, Tibet, central Asia and Japan. o Egyptian Medicine: Egyptian civilization had well-advanced medicine, which is reported to have reached its peak in the days of Imhotep (2800 BC). Chinese Medicine: There are well-documented records of Chinese medicine since 2700 BC. Some of the medicinal practices of those times are still followed in various forms. Mesopotamian Medicine: The Codes of Hammurabi, in name of King of Baby Lone, were lbrmulated around 2000 BC in the Mesopotamian civilization to govern the conduct of physicians to guide health practices. Greek Medicine: Greek Medicine was most evolved between 460 BC-136 BC and Aesculapius (around 1200 BC) and Hippocrates (460-370 BC) were amongst the leaders in Greek Medicine. Hippocrates is often termed "Father as of Medicine" and the oath drafted by him guides medical ethics even now. Roman Medicine: Roman Medicine emerged from Greek Medicine. Roman Medicine was more about overall health with focus on disease prevention and control (and not restricted to curing illnesses, as was the predominant feature of some other prevalent at that time or earlier). Galen (130-205 AD) was a famous Roman medical teacher, whose teaching lasted till mid of sixteenth century when some recent knowledge on anatomy and physiology emerged. Arab Medicine (unani Medicine): From 500 AD to 1500 AD, Greeko-Roman medical literature was translated into Arabic' The local adaptation gave birth to the unani system of medicines in schools of medicines and hospitals in Baghdad, Damascus and Cairo' The period of 800-l300AD is often referred to as the golden period inArabic medicine' Abu Becr (865 AD-925 AD; also known as Rhazes) and Ibn Sina (980 AD-1d37 AD; also known as Avicenna) are known as two leaders of Arab medicine.

YOJANA June 2019 27 cent of total health service utilization Communicable Diseases (NCDs) is and plenty ofproviders in these systems variations with across Indian states often considered the most urgent reason and it is a great opportunify to tackle (Government India, of 2014). In the for developing and strengthening NCDs as well as other emerging health year 2015-16, people in India spent collaboration between conventional challenges in the country. around INR 63,000 crore on AYUSH and T&CM health sectors. The studv health services (public and private of state level burden of diseases in The global evidence has pointed sector put together), which amounts India has highlighted the emerging towards the need for task shifting to nearly 12 per cent of total health burden of NCDs, which mandates (assigning some of the tasks done expenditure of INR 528,484 crore in higher provision of preventive and by allopathic doctors to other cadres the country as reported in National promotive health services, along of healthcare providers) in health Health Accounts (MOHFW, 20 I 8). with curative and diagnostic services. systems. A lot ofsuch approaches are Many T&CM (especially the standard of care in many resource Discussion and Way Forward Ayurveda, Yoga and Naturopathy) largely focus poor settings and countries. The The current and predicted on principles of wellness and health discourse is aligned with dialogues increasing burden ofchronic and Non- promotion. There is a vast infrastructure for moving from'-centric' to a 'team-based' approach to health Figure 1: Financial allocations for Dept/Ministry of AyUSH (2009-2019) service delivery, where each type

There is o need for exlending similsr reseorch on odditionol ryslems of medicine. More strotegic opprooches ore needed in this qreo including building the knowledge bose for T&CM through futilitoting notionol policies; copo(ity building; further strengthening of quolity ossuronce, sofety, proper use ond

*Ministty effeciiveness of T&CM by-produtts, of AYUSH v,as created in Nov 2014. The budget of the Dept. of AyusH is shown prior to Financial year (FY) 201 5-1 6. proclices ond pructilioners ond by The values are Indian Rupee in Crores and are actual expentliture tilt Fy 2017-18, for Fy 2018-19 integroiing T&CM services into Revised Estimates (kE) andfor FY 2019-20 Budget Estimates (BE). These are values for butlgetary allocation in union budget oflndia. heohhrore service delivery und self- The slate government spending is not part of the figures shown here. heolthcore. Source: Union Budget of Govt of India,.www.indiabudget.gouin

28 YOJANA June 2019 of provider (doctors, nurse, alternative system of medicine, pharmacist, counsellor) play different and complementary roles. India is making some progress in this area through MLHP under H-WCs, yet io.e is needed and is possible through .ngug.-"rt of already available hurlan resources under alternative systems of medicine in delivery of personal, population and public health services.

. The ongoing initiatives at all levels need support through government leadership and financing. The research on different aspects of T&CM uia tl" use ofproven methods and approaches need to be promoted in addition to ensuring the availability

Box 3: Traditional/rndigenous/Alternative Systems of Medicine in India Ayurveda: The Ayurvedic System of Medicine evolved nearly 5000 years ago (3000 BC). The word 'science of Life'and employs treatment Ayurveda means modalities, rr"t u, pr.in.utlon, palliation, prescription exercises and the avoidance of various die1s, of disease causing factors. rn. eyr'ruedl. mearcin", health needs' is more ;h;;;fi;;.,iced for a wide range of commonly.used for preventive and rreatttr anJi.nmunity u""rtir!-"iii"ities. Ayurveda is widely popular in Keiala, Himachal p*d"J, ffi*T.#:ll Xli [.il.oj: cu: arat, karnataru] rauonyu pradesh, Rajasthan, unani Medicine: Ijnani Medicine originated in-the Arab world, though over concepts from a period of time it imbibed some other contemporary systems of medicines i, Eg;;ily.ia, persia, East countries' Iraq, India, china and other Middle unani medicine tieais a patient with diet, or.ilJ*"irr"rapy, exercis;, ;;;;"g", and surgery. Medicine was introduced in India urorrd the lOth."ntrryiaO-ai-J Unani Pradesh' utp."sert it is popular in the states of Andhra Karnataka, Tamil Nadu, Bihar, Madhya Pradesh, Mut u.urt t.u, uttar pradeih, o.tt,i and Rajasthan. Homeopathy: The word 'Homeopathy'is derived from the Greek words, .Homois,meaning .similar,and .pathos, means 'suffering' It originated ' in Germany and was introduced in g g3 India around I 1 0- I t. Homeopathy the law of healing- 'similia similibuscurantur'which is based on means 'likes are cured by likes,. It uses highly individuarized remedies selected to address speciflc symptoms or symptom profiles. It is practiced in muny countries where it is the second most popular and in India, .yri.* of medicine.'H"-;o;;;hy is practiced uu or", in Uttar Pradesh, Kerala, th" country and is popular west Bengai, orissa, Andhra Pradesh, Muhurasht.a, punjab, Tamil Nadu, Bihar, Gujarat and North-Eastern States' In the recentlears, the poprlurity oirr"r"."p",rrv has witnessed some decline. Siddha: This system has originated in India and is amongst the oldest systems of medicine account the patient' hivher in the country. It takes into surroundings, age, sex, race, habitat, diet, appetite, diagnosis' physical condition etc. to arrive at the Siddha Sysfem uses minerai-s, una uttoy, -itul, unil;.rgr and inorganic compounds to treat the patients. il;;t;'; illir," riteratuie H'+;T,i,11ffiY;f:'r'i,T:f i:l?::y;HTffiT:T is h rum, and it is practicea r,.e.iy Sowa-Rigpa: The word combination means the.'science.of healing'and well-documented is considered one of-the oldest living and medical traditions of the world. It originated Bhutan' a"i, riuo a_nd is widely practiced in India, x.purl Mongolia and Russia' In India, this system is practiced mainly in Sikkim, i.*i"rr"r pradesh, Darjeeling Dharamshala, Lahaul and Spiii (Himachar p;uo";;i, fy;::Bl!al)' Ladakh region (Jammu and Kashmir) and in Yoga & Naturopathy'The concepts and practices of Yoga are reported to have originated in India. yoga is being adapted to cor:rect lifestyle by cultivating now a rational,-positive and spiritual attitude towards The role of Yoga techniques in all life situations. the prevention and mitigation of diseases and promotion Yoga is of health are being studied. widely practiced across India and has spread io rnuny other parts of the world. The United Nations (tN) has designated 21't June as 'International Yoga Day'. Naturopathyor the naturopathic medicine is invasive system of medicine a drugless, non- imparling treatments with naturai elements based the onihe theories oi'vitality, toxemia and self-healing capacity of the body, is well as the principtes orrreaiitry living. The .o*.non naturopathy modalities include counseling, diet and fastingtherapy, mud tt lyar;,h*;;y, massage therapy, acupressure, acupuncture, magnet therapy and yoga therapy. "*py,

YOJANA June 2019 29 of these services for the people. There has been increasing research published in peer reviewed sources on effect of Yoga and other T&CM, which have shown beneflcial effects on select health conditions. There is a need for extending similar research on additional systems of medicine. More strategic approaches are needed in this area including building the knowledge base for T&CM through facilitating national policies; capacity building; further strengthening of quality assurance, safety, proper use and effectiveness of T&CM by products, practices and practitioners; and by integrating T&CM services healthcare service and self- into delivery CHITRA MISHRA ANKUR KAUSHIK healthcare. Conclusion

There is a focus, both globally and in India, on strengthening primary healthcare (PHC) and advancing UHC, which would require interventions at all levels of health systems. This is possible if the potential contribution of T&CM to improve health services and health outcomes is fully used and by ensuring that users are able to make informed choices about self-healthcare. The renewed attention on strengthening PHCs and advancing UHC, the recognition of epidemiological shift towards burden of non-communicable diseases and the availability of trained health resources and extensive infrastructure in T&CM are opportunities on which India Mahr.s, Pre-Cum-Maha can embark upon for becoming a healthy nation. This would Offiine/Online also need the right mix of preventive, promotive and curative health services and increasing integration of traditional, with P ersonal Attention complementary and alternative systems of medicine (T&CM) in conventional health system. It is time to strategize in order to optimally utilize the knowledge, expertise and resources in T&CM to improve health outcome for citizens and advance UHC in India. History &Culture Geography & Envt. References: I A, Mangtoni IndianEconomy . Government of India (2019). Union Budgets of India. Ministry of Finance. Accessed at: https://www.indiabudget. IR &IndianPolity gov.inl Government of India (2019). Ministry of AYUSH 2019. Accessed at: http ://alush. gov. inl Government of India (2018). National Health Accounts of lndia 2015-16. MoHFW, New Delhi. Accessed at:

http : //nhsrcindia. org/update s/national-health-accounts-

estimates-india-20 I 5- 1 6 Government of India (201 8). National Health Profile 201 8. Accessed at: http ://www.cbhidghs.nic.inlWriteReadData/ 1892s/Before per cent20Chapterl.pdf Govt of India (2014). Report of 71" round of National Sample Survey data. MOSPI, New Delhi. Accessed at: http ://mospi.nic. in/sites/default/fi les/national:data:bank/ ndb-rpts-71.htm World Health Orgarization (2013). WHO Traditional nredicine strategy 2014-23. WHO; Geneva 2013 Access € Link: https ://www.who.int/medicines/publications/ N traditional/trm:strategyl4:23lenl n sN

(E-mail. c. [email protected]; lahariyac@,who.int) t!

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